Skip to main content

Advertisement

Log in

Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To evaluate the post treatment changes in disease activity and inflammatory markers over time in longitudinal follow-up involving different subtypes of juvenile idiopathic arthritis (JIA) patients.

Methods

This prospective longitudinal study, carried out over a period of 2 y, included JIA patients, both old and new, with high disease activity. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, CHAQ (Childhood Health Assessment Questionnaire) score and JADAS27 (Juvenile Arthritis Disease Activity score with 27 active joint counts) were estimated at the initial visit, 6 mo, 12 mo and 18 mo of follow-up.

Results

Out of 40 patients, 10 had persistent oligoarthritis, 11 had rheumatoid factor (RF) positive polyarthritis, 8 had RF negative polyarthritis and 11 had systemic JIA. Twenty-one of them were females. Serum ferritin was highly elevated in systemic JIA patients with a range of 750–7712 ng/ml at the initial visit. All three inflammatory markers with disease activity score decreased significantly over 18-mo-period in all four subtypes. At any visit, all these parameters had largest value in systemic arthritis and least in oligoarthritis variety. At 18 mo, all oligoarthritis and polyarthritis cases had low or inactive disease while none of the systemic JIA patients achieved inactive disease. Elevated ESR and serum ferritin was found in all at 18 mo. CRP normalized in some with low or moderate disease activity.

Conclusions

Inflammatory markers and disease activity decreased in all subtypes of JIA with treatment without biologics. Acute phase markers often remain elevated in inactive disease state. Similarly, normal level of an inflammatory marker does not necessarily indicate absence of active disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Petty RE, Southwood TR, Manners P, et al. International league of Association for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.

    PubMed  Google Scholar 

  2. Duffy CM, Colbert RA, Laxer RM, Schanberg LE, Bowyer SL. Nomenclature and classification in chronic childhood arthritis: time for a change? Arthritis Rheum. 2005;52:382–5.

    Article  PubMed  Google Scholar 

  3. Consolaro A, Ruperto N, Bazso A, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;61:658–66.

    Article  PubMed  Google Scholar 

  4. Nordal EB, Zak M, Aalto K, et al. Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting. Ann Rheum Dis. 2012;71:1122–7.

    Article  CAS  PubMed  Google Scholar 

  5. Viola S, Felici E, Magni-Manzoni S, et al. Development and validation of a clinical index for assessment of long-term damage in juvenile idiopathic arthritis. Arthritis Rheum. 2005;52:2092–102.

    Article  PubMed  Google Scholar 

  6. Susic GZ, Stojanovic RM, Pejnovic NN, et al. Analysis of disease activity, functional disability and articular damage in patients with juvenile idiopathic arthritis: a prospective outcome study. Clin Exp Rheumatol. 2011;29:337–44.

    CAS  PubMed  Google Scholar 

  7. Bazso A, Consolaro A, Ruperto N, et al. Development and testing of reduced joint counts in juvenile idiopathic arthritis. J Rheumatol. 2009;36:183–90.

    PubMed  Google Scholar 

  8. Lomater C, Gerloni V, Gattinara M, Mazzotti J, Cimaz R, Fantini F. Systemic onset juvenile idiopathic arthritis: a retrospective study of 80 consecutive patients followed for 10 years. J Rheumatol. 2000;27:491–6.

    CAS  PubMed  Google Scholar 

  9. Flatø B, Lien G, Smerdel A, et al. Prognostic factors in juvenile rheumatoid arthritis: a case-control study revealing early predictors and outcome after 14.9 years. J Rheumatol. 2003;30:386–93.

    PubMed  Google Scholar 

  10. Wallace CA, Ruperto N, Giannini EH. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004;31:2290–4.

    PubMed  Google Scholar 

  11. Pouchot J, Ecosse E, Coste J, Guillemin F, French Quality of Life Study Group, Paediatric Rheumatology International Trials Organisation. Validity of the childhood health assessment questionnaire is independent of age in juvenile idiopathic arthritis. Arthritis Rheum. 2004;51:519–26.

    Article  PubMed  Google Scholar 

  12. Consolaro A, Bracciolini G, Ruperto N, et al. Remission, minimal disease activity and acceptable symptom state in juvenile idiopathic arthritis. Arthritis Rheum. 2012;64:2366–74.

    Article  PubMed  Google Scholar 

  13. Consolaro A, Ruperto N, Bracciolini G, et al. Paediatric rheumatology international trials organization (PRINTO). Defining criteria for high disease activity in juvenile idiopathic arthritis based on the juvenile arthritis disease activity score. Ann Rheum Dis. 2014;73:1380–3.

    Article  PubMed  Google Scholar 

  14. Pelkonen P, Swanljung K, Siimes MA. Ferritinemia as an indicator of systemic disease activity in children with systemic juvenile rheumatoid arthritis. Acta Paediatr Scand. 1986;75:64–8.

    Article  CAS  PubMed  Google Scholar 

  15. Zhou YF, Li CF, Wang J, et al. Value of serum ferritin in measuring the activation and prognosis in systemic onset juvenile idiopathic arthritis. Zhonghua Yi Xue Za Zhi. 2013;93:2487–9.

    CAS  PubMed  Google Scholar 

  16. Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum. 2005;52:3554–62.

    Article  PubMed  Google Scholar 

  17. Fantini F, Gerloni V, Gattinara M, Cimaz R, Arnoldi C, Lupi E. Remission in juvenile chronic arthritis: a cohort study of 683 consecutive cases with a mean follow-up of 10 years. J Rheumatol. 2003;30:579–84.

    PubMed  Google Scholar 

  18. Packham JC, Hall MA. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology. 2002;41:1428–35.

    Article  CAS  PubMed  Google Scholar 

  19. Foster HE, Marshall N, Myers A, Dunklet P, Griffiths ID. Outcome in adults with juvenile idiopathic arthritis: a quality of life study. Arthritis Rheum. 2003;48:767–75.

    Article  PubMed  Google Scholar 

  20. Sherry DD, Stein LD, Reed AM, Schanberg LE, Kredich DW. Prevention of leg length discrepancy in young children with pauciarticular juvenile rheumatoid arthritis by treatment with intraarticular steroids. Arthritis Rheum. 1999;42:2330–4.

    Article  CAS  PubMed  Google Scholar 

  21. Ungar WJ, Costa V, Burnett HF, Feldman BM, Laxer RM. The use of biologic response modifiers in polyarticular-course juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum. 2013;42:597–618.

    Article  CAS  PubMed  Google Scholar 

  22. Kearsley-Fleet L, Davies R, Lunt M, Southwood TR, Hyrich KL. Factors associated with improvement in disease activity following initiation of etanercept in children and young people with juvenile idiopathic arthritis: results from the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study. Rheumatology (Oxford). 2016;55:840–7.

    Article  Google Scholar 

  23. Woerner A, Uettwiller F, Melki I, et al. Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent. RMD Open. 2015;1:e000036.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are thankful to all the faculties and postgraduate trainees of Department of Pediatrics, I.P.G.M.E. & R., Kolkata, for their help.

Contributions

SS, GD and SD were involved in conception and design of the study. MMA and SS searched the literature. SS, GD and SD were involved in patient management and data collection. AH and MMA were involved in analysis and interpretation of data. MMA and SS drafted the manuscript. SS critically reviewed the manuscript. All the authors finally approved the manuscript. SD will act as the guarantor.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sumantra Sarkar.

Ethics declarations

Conflict of Interest

None.

Source of Funding

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarkar, S., Alam, M.M., Das, G. et al. Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis. Indian J Pediatr 84, 349–356 (2017). https://doi.org/10.1007/s12098-017-2292-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-017-2292-6

Keywords

Navigation